TAM (Treatments and Medicines) NHS Highland
Important: Therapy notes
Oral preparations for acne (Formulary: Dermatology)
What's new / Latest updates
09/12/25 (v1.1):
- Doxycycline capsules added - First line for moderate to severe acne.
- Oxytetracycline tablets added - Second line for moderate to severe acne.
- Erythromycin tablets added - Alternative for patients who cannot tolerate tetracyclines (especially in pregnancy).
- Co-cyprindiol tablets added - Alternative for females with severe or hormonal acne. To be reviewed after 6 months.
02/06/25 - doxycycline dosage wording amended from - '100mg daily, for at least 3 months' to '100mg daily, for 3 months and then review'.
Refer to guidelines and notes on Management of acne and National Patient Pathways.
Important: Therapy notes
MHRA advice:
- Erythromycin: caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban (December 2020) (www.gov.uk).
Important: Therapy notes
Safety advice:
- MHRA: Cyproterone acetate: new advice to minimise risk of meningioma (June 2020) (www.gov.uk).
- CSM advice in BNF and https://www.fsrh.org/documents/cec-ceu-statement-dianette-jun-2013/: Co-cyprindiol carries an increased risk for venous thromboembolism. The risk increases with increasing BMI; avoid co-cyprindiol in patients with a BMI above 35kg/m2.
Important: Formulation and dosage details
Formulation:
Tablets (cyproterone acetate 2mg, ethinylestradiol 35 micrograms)
Dosage:
ALTERNATIVE OPTION: for females with severe or hormonal acne. To be reviewed after 6 months.
- 1 tablet daily for 21 days starting on the first day of the menstrual cycle and repeated after a 7-day interval, usually for several months.
- Withdraw treatment 2 menstrual cycles after acne has resolved.
- Repeat courses may be given if recurrence.
- Co-cyprindiol provides effective contraception. An additional hormonal contraceptive should NOT be used in combination with co-cyprindiol.
Important: Therapy notes
MHRA advice:
- Isotretinoin (Roaccutane): introduction of new safety measures, including additional oversight of the initiation of treatment for patients under 18 years of age (October 2023) (www.gov.uk).
- New safety measures to be introduced in the coming months, including additional oversight on initiation of treatment for patients under 18 years (April 2023) (www.gov.uk).
- Temporary advice for management of oral retinoid medicines during the COVID-19 pandemic (June 2021) (www.gov.uk).
- Isotretinoin (Roaccutane): reminder of important risks and precautions (August 2020) (www.gov.uk).
- Oral retinoid medicines: revised and simplified pregnancy prevention educational materials for healthcare professionals and women (June 2019) (www.gov.uk).
Important: Formulation and dosage details
Formulation:
Capsules 5mg, 10mg, 20mg
Prescribing restriction: Specialist use only:
- Isotretinoin should only be prescribed by or under supervision of Physicians with expertise in the use of systemic retinoids for the treatment of severe acne and a full understanding of the risk of isotretinoin therapy and monitoring requirements.